Provider Demographics
NPI:1649214230
Name:STAROSCIAK, NANCY LEE ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:LEE ANN
Last Name:STAROSCIAK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:LEE ANN
Other - Last Name:STAROSCIAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 1132
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-1132
Mailing Address - Country:US
Mailing Address - Phone:508-995-6001
Mailing Address - Fax:508-995-7067
Practice Address - Street 1:846 ASHLEY BLVD
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-2403
Practice Address - Country:US
Practice Address - Phone:508-995-6001
Practice Address - Fax:508-995-7067
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2751152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0336734Medicaid
MAT59308Medicare UPIN
MA0336734Medicaid